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Approaches to the diagnosis of borderline conditions by use of psychological tests.

The use of psychological tests in the diagnosis of borderline conditions by application of five approaches to the test battery is illustrated on a patient who was diagnosed as borderline by the criteria of both Gunderson and Kernberg. These approaches in terms of (a) structural variables, (b) response to confrontation, (c) severity of illness, (d) symptom diagnosis, and (e) differential response to tests of varying structure, may be used to strengthen each other and to facilitate the diagnosis of borderline patients.

Adult↗

Psychological tests and the borderline diagnosis.

Contrary to recent optimistic claims there is no solid evidence to support the hypotheses that (a) a Borderline's Rorschach is more disturbed than a schizophrenic's, or (b) a Borderline presents disturbance on unstructured tests but not on structured tests. The group research clearly refutes the first hypothesis. The supposedly supportive research for the second hypothesis is either irrelevant, extremely weak, or refutable. Future research needs to explicate the subject sample's symptom, defense, and demographic characteristics, to estimate the base rates of the syndrome and hit rates of the test pattern in order to calculate the conditional probability of being Borderline given the test pattern, and to use a multimethod, multidiagnostic model of validation.

Borderline Personality Disorder↗

Borderline psychopathology as displayed on psychological tests.

Despite the surge of interest in borderline psychopathology in psychiatric quarters, contributions from the perspective of psychological testing have been few. A brief delineation of the range of borderline psychopathology is offered. Broad trends in the test performance of patients within the borderline range are described with regard to: intelligence and cognitive operations, thought and language, reality testing, organization of affect, configuration of defenses, structure of the object world, dynamics and the interpersonal aspects of the test process.

Affect↗

Boundary disturbance in borderline and psychotic states.

This study examines evidence for boundary disturbances in depressive, borderline, and schizophrenic hospitalized inpatients. Certain thought disorder signs on the Rorschach are reconceptualized as indices of boundary formation, which is defined as the capacity to create particular distinctions along wome bipolar coordinate of experience where previously no distinction was possible, and which defines each cluster of experience through a maintenance of differential functioning. The borderline group scored significantly high on the indices of laxness and moderately severe inner-outer boundary formation. The schizophrenic group scored significantly higher on indices of self-other and somewhat higher on severe inner-outer boundary disturbance. Schizophrenics may be organized at a level of self-other boundary formation which subsumes inner-outer boundary formation, while the borderline group is organized at a level of inner-outer boundary formation.

Adolescent↗

An exploration of separation-individuation themes in the borderline personality disorder.

In an attempt to test hypotheses derived from Mahler's theory of borderline development, Rorschach protocols of borderline and schizophrenic patients were studied for the presence of themes related to the separation-individuation process. A specially constructed Separation-Individuation Theme Scale was used with a 96% reliability of agreement between two raters. The borderline group attained more separation-individuation themes than the schizophrenic group, whereas the schizophrenics showed more preseparation-individuation themes. The results were interpreted as a validation of Mahler's theory. In addition, the results tended to confirm a developmental model for the understanding of psychopathology.

Adolescent↗

The MMPI, prototypal typology, and borderline personality disorder.

This study demonstrates inherent features in the DSM-III diagnostic criteria for personality disorders (i.e., overlapping diagnoses and heterogeneous symptomatology) that limit efforts to identify a sensitive and specific MMPI profile for the borderline personality disorder. A sample of 71 inpatients was administered an MMPI and a semistructured interview that systematically evaluated each of 81 symptoms for the 11 DSM-III personality disorders. Interrater reliability was substantially higher than has been obtained with unstructured interviews. The effect on the borderline MMPI profile of variation in the number of borderline symptoms and overlap with the schizotypal, histrionic, and antisocial diagnoses was demonstrated. We discuss implications with respect to a prototypal model of classification.

Adult↗

Borderline and schizotypal personality disorders: mutually exclusive or overlapping?

This article is concerned with one aspect of the validity of DSM-III Axis II diagnoses, namely, the discriminability of borderline and schizotypal disorders. Forty-nine patients diagnosed by DSM-III criteria as borderline, schizotypal, or "mixed" personality disorders completed the Borderline Syndrome Index (BSI), an independent self-report 52-item instrument that has been shown to be reliable and to have discriminative validity. A one-way analysis of variance and a discriminant function analysis were conducted. Our major finding was that there were no significant differences among the groups on the BSI self-report test, although there were differences on clinical grounds. We discuss this in terms of "fuzzy set" theory and prototypic systems of classification.

Adult↗

The rorschach assessment of borderline defenses: a concurrent validity study.

This study assesses the concurrent validity of two Rorschach defense scales designed to identify borderline defensive structure. A Rorschach scale designed by Cooper and his colleagues was systematically compared to a defense scale constructed by Lerner and Lerner. Despite considerable overlap on a conceptual and operational level, the scales are based on divergent theoretical models (developmental arrest and fixation) and Rorschach units of analysis (all responses and human responses). Our results are based on the capacity of each scale to discriminate between independently diagnosed samples (neurotic, outpatient borderline, inpatient borderline, schizophrenic) and the relative discriminatory power of particular defenses within each scale to differentiate between groups.

Adolescent↗

MCMI-II diagnosis of borderline personality disorder: base rates versus prototypic items.

The Millon Clinical Multiaxial Inventory-II (MCMI-II) profiles of 26 psychiatric inpatients diagnosed as having borderline personality disorders were compared with profiles of 42 patients with no personality disorders. The borderline group scored significantly higher on the following scales: Disclosure (X), Debasement (Z), Passive-Aggressive (8A), Self-Defeating (8B), Borderline (C), and Major Depression (CC). Differences approaching significance were also found on substance abuse measures: the Alcohol Dependence (B) scale and Drug Dependence (T) scale. These findings are consistent with criteria established in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) and the results of other studies utilizing the MCMI-II. In addition, diagnostic efficiency of Scale C was assessed at various cutoff points defined by either base rate (BR) scores or the number of prototypic items endorsed. The greatest efficiency was found when a cutoff of seven or more prototypic items was utilized, with nearly 80% of the patients correctly classified. Results are discussed in terms of their relevance for further research.

Adult↗

Impact of simulating borderline personality disorder on the MMPI-2: a costs-benefits model employing base rates.

This investigation extends current work on the impact of role-specific response sets on dissimulated Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles. Specifically, one group of subjects was given specific symptom information and instructed to simulate borderline personality disorder on the MMPI-2. This dissimulation performance was compared to a clinical comparison group of clients diagnosed with borderline personality disorder, a group of subjects instructed to simulate major depression, and a group of subjects who responded honestly to the MMPI-2. In both simulating conditions, subjects produced significantly higher elevations on a majority of clinical and validity scales than the clinical comparison group. A rigorous evaluation of the F scale was conducted to provide a range of predictive values for different F scale cutting scores for detecting malingering. Sensitivity, specificity, and positive and negative predictive power were computed for this range of F scale values. A similar analysis was conducted for the Borderline Personality Disorder Scale (BPDsc) of Morey, Waugh, and Blashfield (1985). These results are integrated with extant research. A costs-benefits model is proposed for employing F scale cutting scores in clinical situations with different base rates of malingering.

Adolescent↗

Effectiveness of time-limited cognitive analytic therapy of borderline personality disorder: factors associated with outcome.

Most patients with borderline personality disorder receive no formal treatment for their personality disorder and psychotherapy is widely believed to be necessarily intensive, of long duration and of uncertain effect. This study seeks to demonstrate the scope and limits of time-limited outpatient cognitive analytic psychotherapy. Cases were identified by standard diagnostic procedures. Most were referred from psychiatrists and were typical of inner city patient populations. At an assessment 6 months after therapy the 27 patients completing therapy were divided into 'improved' and 'unimproved' groups. The patients classified as improved no longer met diagnostic criteria for borderline personality disorder. The two-thirds still traceable were re-tested at 18 months. These groups were compared in terms of a number of pre-therapy measures and features. Poorer outcome was associated with greater severity of borderline features, a history of self-cutting, alcohol abuse and unemployment.

Adult↗

Borderline personality disorder features: the role of self-discrepancies and self-complexity.

OBJECTIVES: Borderline personality disorder (BPD) involves disordered self-conceptions, along with dysphoria and anxiety. The present study examined the role of actual-ideal (AI) and actual-ought (AO) self-discrepancies, and self-complexity as predictors of borderline personality features in a student population. METHOD: AI and AO self-discrepancy magnitudes across all self-domains were assessed, along with self-complexity, idiographically and nomothetically. Borderline personality features were assessed using subscales of the Minnesota Multiphasic Personality Inventory (MMPI-2). RESULTS: Both AI and AO self-discrepancies were directly related to BPD personality features, in that those with larger self-discrepancies of both types reported more features. Self-complexity had no direct relationship to BPD personality features; rather, it moderated the relationship between AI, but not AO, self-discrepancies and BPD personality features. For individuals low in self-complexity, a stronger relationship between AI self-discrepancies and BPD personality features existed. CONCLUSIONS: This study is novel in its consideration of the impact of features of the self-system on BPD personality features. It highlights the important role that AO self-discrepancies, and the combined role of AI self-discrepancies and self-complexity, have in increasing vulnerability to BPD. The findings suggest that different pathways might be involved in the vulnerability to BPD, depending on self-discrepancy type and level of self-complexity.

Adolescent↗

Playing with reality: III. The persistence of dual psychic reality in borderline patients.

This paper is a contribution towards understanding the difficulties of severely borderline patients as they are uncovered within the psychoanalytic process. The authors aim to extend a model from previous papers, bringing a developmental perspective to bear on self-representation and self-organisation. This model rests on an understanding of the child's experience of psychic reality in both normal and neurotic people. The authors explore the relevance of these developmental ideas in thinking about severe borderline and related disturbances seen in adult patients, from the point of view of both understanding the pathology and considering technique. Illustrations are given from a case that helped to prompt the formulation of these states in terms of persistent, pervasive distortions of the experience of psychic reality. There is then an attempt to elucidate the difficulties of borderline patients in tolerating both separation and intimacy, consideration of the way in which bodily experiences may be used as an equivalent of mental experience or contact, and a discussion of the impact of disturbances in the experience of psychic reality on the analytic process.

Adult↗

Borderline personality organization and psychopathic traits in nonclinical adolescents: relationships of identity diffusion, primitive defense mechanisms and reality testing with callousness and impulsivity traits.

Although psychotherapeutic observation and empirical data suggest a link between borderline and antisocial personality disorder or traits in adolescents, there is no study on the relationships of borderline personality organization (BPO) and psychopathic traits in adolescents. The aim of this study was to explore the relationship of structural criteria of (BPO) as assessed by the French version of the Borderline Personality Inventory (BPI), with psychopathic traits, as assessed by the French version of the Levenson Self-Report Psychopathy Scale (LSRP), in a nonclinical sample of 243 adolescents. Significant correlations were found between the BPI scales of identity diffusion, primitive defense mechanisms, impaired reality testing, and psychopathic traits of callousness and impulsivity, suggesting that BPO may contribute to psychopathic traits in nonforensic, nonclinical adolescents.

Adolescent↗

Patient-therapist attachment in the treatment of borderline personality disorder.

The authors report preliminary findings from a longitudinal study on the impact of attachment state of mind and reflective function on therapeutic process and outcome with borderline patients in Transference-Focused Psychotherapy (TFP). TFP is a manualized, psychoanalytically oriented treatment based on an object relations model of understanding patients with severe personality disorders. The attachment theory constructs of internal working models of attachment and mentalization or reflective function provide an important means of both conceptualizing borderline disorders and assessing therapeutic process and change. In the Personality Disorders Institute at New York Presbyterian Hospital-Weill Medical College of Cornell University, the authors have been using the Adult Attachment Interview (AAI) to assess changes in state of mind with respect to attachment and reflective function over the course of 1 year in borderline patients in TFP treatment. As part of the authors' investigations of the impact of patients' attachment status on the therapeutic process, they have adapted the AAI to evaluate states of mind with respect to attachment within the therapeutic relationship through an interview called the Patient-Therapist Adult Attachment Interview (PT-AAI). The AAI is given at 4 months and 1 year, and the PT-AAI is given to patients after 1 year of TFP, and both interviews are scored for attachment classification and reflective function. The authors present preliminary findings on change in both attachment classification and reflective function ratings at 4 months and 1 year for a subsample of 10 patients and therapists. They also present two cases that illustrate how the quality of mentalization or reflective function in the therapeutic dyad may be seen as a bidirectional process in that therapists' and patients' levels of reflective function are mutually and reciprocally influential. In one case, the patient's and therapist's reflective function mirrored each other directly and remained at a low or rudimentary level for the treatment year. Such a pattern of direct imitation does not necessarily promote intrapsychic change. In the second case, the patient moved from a rejecting or bizarre stance toward mentalization on the AAI to some rudimentary consideration of mental states after 1 year of treatment with a therapist who showed a full and nuanced awareness of mental states, but who adjusted his level of mentalization to that of the patient. These findings suggest that optimally the therapist ought to be one step ahead of the patient in the capacity for mentalization.

Adult↗

Borderline personality organization in violent offenders: correlations of identity diffusion and primitive defense mechanisms with antisocial features, neuroticism, and interpersonal problems.

Although theoretical assumptions and empirical evidence suggest an association between borderline personality disorder (BPD) and antisocial behavior or even antisocial personality disorder (APD), there is no study relating the psychodynamic aspects of BPD to antisocial behavior. In this study, the authors tested the correlation between the structural criteria of borderline personality organization (BPO)--that is, identity diffusion, primitive defense mechanisms, and reality testing--and antisocial features, neuroticism, and interpersonal problems. A sample of imprisoned violent offenders (N = 91) was studied using the Antisocial Personality Questionnaire (APQ), the Borderline Personality Inventory (BPI), the Neo-Five-Factor-Inventory (Neo-FFI), and the Inventory of Interpersonal Problems (IIP). Significant correlations were predicted and found between the BPI scales of identity diffusion, primitive defense mechanisms, impaired reality testing, and fear of closeness and antisocial features, neuroticism, agreeableness, and interpersonal problems. The results are consistent with both object relations theory and attachment theory.

Adult↗

The experience of borderline phenomena through cinema: Guentin Tarantino's Reservoir dogs, true romance, and pulp fiction.

The experience of many patients with borderline personality is intense and kaleidoscopic. These qualities may be represented in film in ways that reflect and convey their essential features that are less readily captured in words. Quentin Tarantino has produced a trilogy of films that bring to light and to life the borderline experience. We use these movies to illustrate and discuss five key borderline themes: the fluid nature of drive derivatives, the discontinuous experience of time and space, the coniflicted search for an idealized parent, antisocial distortions of the superego, and the organizing and stabilizing function of a central romantic fantasy.

Borderline Personality Disorder↗

Attachment, parental bonding and borderline personality disorder features in young adults.

The relations between parental bonding and attachment constructs and borderline personality disorder features were examined in a sample of 393 18-year-old participants. Hierarchical regression analyses revealed that parental bonding and attachment scores (especially insecure attachment, anxious or ambivalent attachment, and a perception of a relative lack of caring from one's mother) were uniquely associated with borderline features beyond what could be accounted for by gender, childhood adversity experiences, Axis I disorder, and nonborderline Axis II symptoms. Although relatively modest, these relations suggest that bonding and attachment constructs might be considered in comprehensive etiological models of borderline personality disorder.

Adolescent↗